• 생명과학회지
• /
• 제28권10호
• /
• pp.1220-1232
• /
• 2018

본 연구는 토끼의 상악동에 Bio-Oss와 ${\beta}-TCP$를 이식한 후 골 재생 과정을 조직학적으로 비교하기 위하여 수행되었다. 12마리의 수컷 토끼를 4마리씩 3군으로 구분하였다. 토끼의 양쪽 상악동 점막을 거상한 후 한쪽은 Bio-Oss를 이식하였고, 다른 쪽은 ${\beta}-TCP$를 이식한 후 본래의 골편으로 창을 봉합하였다. 2주, 4주 및 8주 후에 토끼를 희생시키고 조직절편을 만든 후 Bio-Oss군과 ${\beta}-TCP$군의 골 재생 양상을 비교하였다. 조직계측학적 분석을 위하여 각각의 조직절편에 hematoxylin-eosin, Masson trichrome 및 tartrate-resistant acid phosphatase 염색을 하였고, proliferating cell nuclear antigen (PCNA), type I collagen 및 osteocalcin의 발현 양상을 비교하기 위하여 면역조직화학 염색을 하였다. 광학현미경 시야에서 계측프로그램을 이용하여 계측하고 분석하여 다음과 같은 결과를 얻었다. Bio-Oss군과 ${\beta}-TCP$군 모두 2주군에서 초기 골 형성이 시작되었고, 4주군에서는 각 이식재 입자의 표면에 형성된 다량의 신생골이 관찰되었으며, 8주군에서는 신생골의 골량이 더 증가되어 있었고 층판골과 골수조직도 관찰되었다. 신생골의 양은 4주군까지 두 군이 비슷하였으나, 8주군에서는 ${\beta}-TCP$군에서 유의한 증가가 계측되었다. 이식재의 양은 4주군부터 8주군까지 ${\beta}-TCP$군에서 유의하게 감소되었으며, 파골세포의 수는 4주군에서 8주군까지 ${\beta}-TCP$군에서 유의하게 증가되어 있었다. PCNA에 대한 면역반응성은 8주군에서 감소되었지만 두 군간의 유의한 변화는 없었다. Type I collagen의 발현은, 2주군에서는 ${\beta}-TCP$군에서 유의하게 증가되었지만, 8주군에서는 Bio-Oss군에서 유의한 증가가 관찰되었다. Osteocalcin에 대한 면역반응성은 8주까지 증가되었으며 두 군간의 유의한 차이는 없었다. 이러한 조직학적 결과들은 임플란트를 위한 이식재의 선택에 도움을 줄 수 있다. 이상의 결과들을 종합하면 Bio-Oss와 ${\beta}-TCP$는 모두 검증된 이식재 이지만, 토끼의 상악동 거상술에서는 ${\beta}-TCP$가 좀 더 우수한 골 재생 결과를 보였다.

• Journal of Korean Dental Science
• /
• 제13권2호
• /
• pp.73-80
• /
• 2020

Purpose: The purpose of this case study series was to introduce successful implant cases that used the palatal bone in patients with severe maxillary alveolar bone atrophy or defects. Case Presentation: In this case series study, a total of four patients underwent implant placement in the palatal bone of the maxilla. A total of 6 implants were installed using the palatine bone. The patients' ages ranged from 40 to 73 years with an average age of 63.5 years. The patients had maxillary sinus-related diseases, such as maxillary sinusitis, oroantral fistula, and dentigerous cysts, prior to implantation. To achieve initial stability, the implants were placed on the palatal side, and buccally tilted. The average postoperative recovery period was 8 months. No postoperative complications occurred in any of the cases, and the approach was used without reported issues. Conclusion: Implant treatment by securing the initial fixation in the palatal bone is a good alternative when an implant must be installed in a patient who requires extensive and invasive bone graft.

• Journal of Periodontal and Implant Science
• /
• 제47권2호
• /
• pp.86-95
• /
• 2017

Purpose: The aim of this study was to determine the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2)-loaded synthetic bone substitute on implants that were simultaneously placed with sinus augmentation in rabbits. Methods: In this study, a circular access window was prepared in the maxillary sinus of rabbits (n=5) for a bone graft around an implant (${\varnothing}3{\times}6mm$) that was simultaneously placed anterior to the window. Synthetic bone substitute loaded with rhBMP-2 was placed on one side of the sinus to form the experimental group, and saline-soaked synthetic bone substitute was placed on the other side of the sinus to form the control group. After 4 weeks, sections were obtained for analysis by micro-computed tomography and histology. Results: Volumetric analysis showed that the median amount of newly formed bone was significantly greater in the BMP group than in the control group ($51.6mm^3$ and $46.6mm^3$, respectively; P=0.019). In the histometric analysis, the osseointegration height was also significantly greater in the BMP group at the medial surface of the implant (5.2 mm and 4.3 mm, respectively; P=0.037). Conclusions: In conclusion, an implant simultaneously placed with sinus augmentation using rhBMP-2-loaded synthetic bone substitute can be successfully osseointegrated, even when only a limited bone height is available during the early stage of healing.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제35권3호
• /
• pp.170-175
• /
• 2009

Purpose : The purpose of this study is to evaluate 7-year survival rate of implants placed without bone graft in posterior maxilla and compare the survival rate by the age and gender of patient, length and diameter of implant, region of implant placement, bicortical engagement of fixture, and connection of prosthesis. Material and methods : 78 patients (170 implants) who visited our institution from 2002 to 2007 and were followed up with panoramic view and medical records. Kaplan-Meier survival analysis and Log Rank (Mantel-Cox) test were used. Results and conclusions : A 7-year cumulative survival rate for implants placed in posterior maxilla without sinus graft was 95.3%. The survival rate in men was 91.8%, significantly lower than 98.8% in woman.(p<0.05). However, the survival rate by the length of the implants did not show any significant differences.(p>0.05), while the wide platform implant resulted in 85% survival rate which was statistically lower than 98.5% in regular platform. The posterior maxillary implants engaged bicortically showed 97.6% of 7-year Survival rate, comparing 88.6% in not engaged implants. The survival rate of the single implant was 91.2%, while 98.5% in splinted prosthesis. Therefore, the bicortical engagement of the fixtures and splinted prosthesis may be recommended to get a long-term survival rate in posterior maxilla.

• 구강회복응용과학지
• /
• 제30권4호
• /
• pp.278-288
• /
• 2014

목적: 이 연구의 목적은 상악 및 하악의 완전 무치악 및 부분 무치악 부위에 식립된 골유착성 임플란트의 보철 전 초기 생존율 및 생존과 관련된 요소를 평가하고 실패를 야기하는 요인에 대해 알아보는 것이다. 연구 재료 및 방법: 2004년부터 2013년까지 770명의 환자에서 총 2158개의 골내 임플란트를 식립하였다. 임플란트의 소실과 환자의 연령 및 성별, 식립 위치, 임플란트 시스템, 길이 및 직경, 그리고 골이식 방법과의 연관성을 평가하기 위해 임상적 비교를 시행하였다. 결과: 임플란트 식립 위치에 따라 상악 전치부에서 98.23%, 상악 구치부 96.97%, 하악 전치부 97.85%, 하악 구치부 98.75%의 임플란트 생존율을 보였다(P < 0.05). 임플란트의 종류 및 표면처리 기법은 임플란트 생존율과 특이성을 보이지 않았다. 임플란트 매식체의 직경에 따라 3.0 mm 이하의 임플란트에서 100%, 3.0 - 3.5 mm 97.09%, 3.5 - 4.0 mm 98.19%, 4.0 - 4.5 mm 98.29%의 생존율을 보였고, 5.0 mm 이상의 직경을 가진 넓은 폭경의 임플란트에서 75%의 비교적 낮은 생존율을 보였다(P < 0.05). 임플란트 매식체의 길이에 따라 9 - 11 mm 및 11 - 13 mm의 길이를 가진 임플란트에서 각각 98.12% 및 98.17%의 높은 생존율을 보였으나 통계학적 유의성을 가지진 못하였다. 골이식술의 방법에 따라 상악동 골이식술을 단독으로 시행한 부위에서 임플란트 생존율은 89.05%, 골유도 재생술을 단독으로 시행한 경우 98.28%, 상악동 골이식술과 골유도 재생술을 동시에 시행한 경우 98.34%, 골이식술이 동반되지 않은 경우 99.28%의 생존율을 보였다(P < 0.05). 결론: 이번 연구에서 임플란트 식립 후 최종 보철물 시적 전 초기단계에서의 임플란트 생존율은 임플란트의 식립위치, 임플란트 매식체의 직경, 그리고 골이식 방법과 관련이 있었다. 이러한 결과에 따라 각각 상악 구치부, 5.0 mm 이상의 넓은 임플란트, 그리고 상악동 골이식술을 단독으로 시행한 부위에서 현저하게 낮은 생존율을 확인할 수 있었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제30권3호
• /
• pp.228-233
• /
• 2004

Summary: The malignant peripheral nerve sheath tumor(MPNST) is an aggressive neoplasm and can either arise independently or result from malignant change in preexisting neurofibromatosis (von Recklinghausen's disease). Its histologic characteristics remain controversial, but currently it is believed that the schwann cell is the origin of the peripheral nerve sheath tumors. MPNST is an uncommon neoplasm of the head and neck region, and its presentation in the oral cavity is quite rare. In this study, we report a patient with a rare case of a MPNST involving the maxilla. A case report: A 29-year-old female presented with a chief complaint of painless swelling with bleeding tendency on the left maxillary tuberosity area 2 months ago. Clinical examination showed a $5.0{\times}3.0cm^2$ sized, indurative swelling on the site. Conventional radiographs showed a relatively well-defined soft tissue mass involving the left maxillary sinus, and destruction of the anterior, posterolateral walls of the left maxillary sinus. Subtotal maxillectomy and split-thickness skin graft from thigh were undertaken. In histochemical and immunohistochemical studies, the specimen revealed positive reactivities to Vimentin and S-100 protein. Final diagnosis was made as MPNST.

• 대한치과의사협회지
• /
• 제55권11호
• /
• pp.756-765
• /
• 2017

Purpose: The purpose of this article is to evaluate a change o bone level on the sinus floor by a bone added osteotome sinus floor elevation (BAOSFE) technique, according to the amount of deproteinized bovine bone mineral (DBBM). And Changes in augmented bone height after BAOSFE procedure were also assessed for 6 months after the implant procedure. Materials and Methods: Forty eight single implants were placed in the posterior maxilla using BAOSFE technique. The implantation sites were classified into two groups according to the amount of grafted DBBM, 0.25 group (0.25g) and 0.5 group (0.5 g). Panoramic views or cone-beam computed tomography (CBCT) were taken at the time of implant placement with BAOSFE and after at least 6 months to assess the bone level changes in the elevated sites with DBBM. Results: Alveolar bone level around all implants was stable clinically and radiographically during the follow-up. Mean augmented bone height was $5.21{\pm}0.94mm$ in 0.25 group and $6.92{\pm}1.19mm$ in 0.5 group. Statistically significant difference in augmented bone height was found in the comparison between the 0.25 group and 0.5 group at the time of surgery. There was a positive correlation between the length of the implant protruding into the maxillary sinus and the augmented bone height. After 6 months, mean reduction of augmented bone height was $0.50{\pm}0.34mm$ in 0.25 group and $0.41{\pm}0.30mm$ in 0.5group. There was no specific correlation between the reduction of augmented bone height and amount of grafted DBBM. Conclusion: Within the limit of this study, the amount of grafting materials and the protrusion length of implant into the maxillary sinus affect the amount of the augmented bone height.

• 대한기관식도과학회지
• /
• 제6권1호
• /
• pp.118-126
• /
• 2000

A radical maxillectomy causes a defect of the alveolar bone, gingiva, palate, and orbital floor and causes cosmetical problems and masticatory and phonatory functions. Defect after a radical maxillectomy was reconstructed with skin or dermis graft was introduced, but recently wide resection of the tumor and functional reconstruction with free flap was introduced by several methods. The defect due to radical maxillectomy was reconstructed with scapula, iliac crest, radius. But reconstruction with a fibular osteocutaneous free flap was rarely introduced to defect of radical maxillectomy. The fibular osteocutaneous free flap was firstly introduced by Taylor. The fibular osteocutaneous free flap has several advantages. We experienced the first case of radical maxillectomy and reconstruction with the fibular osteocutaneous free flap, so we reported that case with literatures. The patient has a right maxillary sinus squamous carcinoma (T2N0M0), and performed a radical maxillectomy with right supraomohyoid neck dissection, and reconstruction with fibular osteocutaneous free flap. Donor site morbidity was little, and phonatory and masticatory function were nearly normalized. And cosmetical result was very acceptable.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제31권1호
• /
• pp.86-91
• /
• 2009

The success of implants essentially depends on a sufficient volume of healthy bone at the recipient site during implant placement. In patients who have the severe alveolar bone resorption or pneumatized maxillary sinus, it should be performed that bone regeneration procedure before implant placement. Development of barrier membrane makes it possible that predictable result of alveolar bone reconstruction. Many kind of materials used for barrier membrane technique are introduced, non-absorbable or absorbable membranes. But, when operation site was ruptured with membrane exposure, bacterias can be grow up at the bone graft site. Then morphology and migration of fibroblast will be changed. It works as a negative factor on healing process of bone graft site. In oral and maxillofacial department of Chonbuk national university dental hospital, we use variable suture technique like as subgingival suture, vertical mattress suture, simple interrupted suture, if need, tenting suture after GBR or block bone graft. Within these suture technique, wound healing was excellent without complication, so now we take a report of suture technique in reconstruction of alveolar bone surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제38권1호
• /
• pp.2-8
• /
• 2012

Introduction: Auto-tooth bone graft material consists of 55% inorganic hydroxyapatite (HA) and 45% organic substances. Inorganic HA possesses properties of bone in terms of the combining and dissociating of calcium and phosphate. The organic substances include bone morphogenetic protein and proteins which have osteoinduction capacity, as well as the type I collagen identical to that found in alveolar bone. Auto-tooth bone graft material is useful as it supports excellent bone regeneration capacity and minimizes the possibility of foreign body reaction,genetic diseases and disease transmission. Materials and Methods: Implant placement combined with osteoinductive regeneration,preservation of extraction socket, maxillary sinus augmentation, and ridge augmentation using block type,powder type, and block+powder type autobone graft materialwere performed for 250 patients with alveolar bone defect and who visited the Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University from September 2009 to August 2011. Results: Clinical assessment: Among the 250 patients of auto-tooth bone graft, clinical assessment was performed for 133 cases of implant placement. The average initial stabilization of placed implants was 74 implant stability quotient (ISQ). Radiological assessment: The average loss of crestal bone in the mandible as measured 6 months on the average after the application of prosthesis load was 0.29 mm, ranging from 0 mm to 3.0 mm. Histological assessment: In the histological assessment, formation of new bone, densified lamellated bone, trabecular bones, osteoblast, and planting fixtures were investigated. Conclusion: Based on these results, we concluded that auto-tooth bone graft material should be researched further as a good bone graft material with osteoconduction and osteoinduction capacities to replace autogenous bone, which has many limitations.